NR 324 Final Exam Study Guide Key Concepts

NR 324 Final Exam Study Guide Key Concepts 1. List the risk factors, assessment findings, diagnostics and/or labs, nursing management including diet, plan of care, medications, and patient teaching for each of the following. Iron deficiency anemia. Risk factors: deficient nutrients, decreased erythropoietin, decreased iron availability, blood loss, increased RBC destruction, very young, poor diet, women in reproductive years(pregnancy). Assessment Findings: Pallor is the most common finding. Glossitis (inflammation of the tongue) is the second most common. Another finding is cheilitis (inflammation of the lips). The patient may report headache, paresthesia, and a burning sensation of the tongue, all of which are caused by lack of iron in the tissues. Clinical manifestations: sensitivity to cold, weight loss, lethargy, pallor, jaundice, pruritis, glossitis, smooth tongue, tachycardia, angina, heart failure, MI, tachypnea, orthopnea, dyspnea at rest, headache, vertigo, irritability. Hemoglobin 6 (severe anemia) Nursing Management: blood transfusion, drug therapy, RBC replacement, O2 alternate rest and activity, aid minimize risk for injury, evaluate nutritional needs, encourage increased intake of foods high in iron. Diagnostics: Hgb, Hct, MVC, MCH, MCHC, reticulocytes, serum iron, TIBC, bilirubin, plt’s, stool occult blood test, endoscopy, colonoscopy Medications/Treatments: Replace iron (diet, oral, parenteral, transfusion of packed RBCs), teaching, emphasize compliance. Patient teaching: Take meds as prescribed, eat iron-rich foods, black tarry stools are okay, constipation can happen; eat fiber-rich food, no contact sports, no straight razors. Thalassemia Thalassemia: is a group of diseases involving inadequate production of normal hemoglobin due to reduced or absent α-globin or β-globin protein decreased erythrocyte production. Thalassemia has an autosomal receive genetic link common in persons of ethnic groups near the Mediterranean Sea, regions of Asia, Middle East, and Africa. S/S: May have both physical and mental developmental delays, jaundice, pallor, hepatomegaly and cardiomyopathy may occur from iron deposits, splenomegaly (Thalassemia major). Management: blood transfusions in conjunction with iron chelation, folic acid, zinc, ascorbic acid and iron should NOT be given, monitor hepatic, cardiac, and pulmonary organ function. Megaloblastic Anemias: 2 TYPES • Caused by impaired DNA SYNTHESIS • EARLY detection and treatment are key • Protect from fallings, burns, and trauma (they have a diminished sensation to heat and pain from the neurologic impairment) • Physical therapy may be needed ▪ Cobalamin Deficiency (vitamin b12) • Without IF (intrinsic factor) a protein that is secreted by partial cell of gastric mucosa there is no EF (extrinsic factor) which is the cobalamin absorption in the ileum. • Manifestations: GI: N/V, Neuromuscular: weakness, swelling of the hands and feet, impaired thought process • Patient education: informed on how to replace the vitamin b12. Reduce alcohol intake, smoking cessation, avoid h2 histamine receptor blockers • Parenteral or intranasal administration is the treatment of choice because there is no absorption occurring in the GI tract. Without the treatment patient’s lifespan is 1-3 years. ▪ Folic Acid Deficiency Causes: Chronic alcoholism(malabsorption), sclerosis of the liver